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<html xmlns:wicket="http://wicket.apache.org">
<wicket:panel>
    <h2>Aanvragen nieuwe uitnodiging baarmoederhalskanker</h2>
    <fieldset class="form-horizontal hero-unit ifobt-gegevens">
        <h3>Gegevens laatste klaargezette/afgedrukte uitnodiging uitstrijkje. Na afronden contact wordt de uitnodiging direct aangemaakt.</h3>
        <div class="row-fluid">
            <div class="span6">
                <div class="control-group value">
                    <label class="control-label">Bevolkingsonderzoek</label>
                    <div class="controls">Baarmoederhalskanker</div>
                </div>
            </div>
            <div class="span6">
                <div class="control-group value">
                    <label class="control-label">Ronde</label>
                    <div class="controls">
                        <span class="badge" wicket:id="rondeNr">2</span>
                    </div>
                </div>
            </div>
        </div>
        <wicket:enclosure child="extraOmschrijving">
        <div class="control-group value">
            <label class="control-label">Gebeurtenis</label>
            <div class="controls">
                <span class="badge badge-inverse"><wicket:container wicket:id="gebeurtenis"></wicket:container> (<span wicket:id="extraOmschrijving"></span>) : <wicket:container wicket:id="datum"> 21-10-2012</wicket:container></span>
            </div>
        </div>
        </wicket:enclosure>        
        <div class="control-group value" wicket:id="gbaMessageContainer">
            <label class="control-label">Opmerking</label>
            <div class="controls">
                <span class="badge"><wicket:message key="message.aanvraagnagba"></wicket:message></span>
            </div>
        </div>

    </fieldset>
</wicket:panel>
</html>
